| NPI | 1902168818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 117753) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CA 6139) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2022-07-21 |